Purpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries,specifically for intra-abdominal inju...Purpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries,specifically for intra-abdominal injury(IAI).The impact of concomitant spinal cord injury(SCI)with the risk of associated IAI has not been well clarified.The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI.Methods:A retrospective cohort study using the Israeli National Trauma Registry was conducted.Patients with thoracic,lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1,1997 to December 31,2018 were examined,comparing the incidence,severity and mortality of IAIs in patients with or without SCI.The collected variables included age,gender,mechanism of injury,incidence and severity of the concomitant IAIs and pelvic fractures,abbreviated injury scale,injury severity score,and mortality.Statistical analysis was performed using GraphPad InStat?Version 3.10,with Chi-square test for independence and two sided Fisher’s exact probability test.Results:Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures.Combined thoracic and lumbar fractures were observed in 1272 patients(7.5%),isolated thoracic fractures in 4967 patients(29.4%)and isolated lumbar fractures in 10,639 patients(63.0%).The incidence of concomitant SCI was found in 4.95%(63/1272),7.65%(380/4967)and 2.50%(266/10639)of these patients,respectively.The overall mortality was 2.5%,proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts(11.3%vs.4.6%,p<0.001).Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts(8.2%vs.3.1%,p<0.001).There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures;although isolated lumbar f展开更多
Background: Morel-Lavallee lesions (MLLs) are rare internal degloving injuries typically caused by blunt traumatic injuries and most commonly occur around the hips and in association with pelvic or acetabular fracture...Background: Morel-Lavallee lesions (MLLs) are rare internal degloving injuries typically caused by blunt traumatic injuries and most commonly occur around the hips and in association with pelvic or acetabular fractures. MLL is often overlooked in the setting of poly-trauma;therefore, clinicians must maintain a high degree of suspicion and be familiar with the management of such injuries, especially in obese poly-trauma patients. Case presentation: We present a 30-year-old female pedestrian struck by a motor vehicle who sustained multiple long bone fractures, a mesenteric hematoma, and full-thickness abdominal skin friction burn which masked a significant underlying abdominal MLL. The internal degloving caused significant devascularization of the overlying soft tissue and skin which required surgical drainage of hematoma, abdominal wall reconstruction with tangential excision, allografting, negative pressure wound therapy, and ultimately autografting. Conclusion: MLL is a rare, often overlooked, internal degloving injury. Surgeons must maintain a high index of suspicion when dealing with third degree friction burns as they may mask underlying injuries such as MLL, and a delay in diagnosis can lead to increased morbidity.展开更多
Common or external iliac artery injury due to blunt trauma is unusual without an associated pelvic fracture.Here we report on a 62 years old man that sustained left external iliac artery thrombosis due to blunt trauma...Common or external iliac artery injury due to blunt trauma is unusual without an associated pelvic fracture.Here we report on a 62 years old man that sustained left external iliac artery thrombosis due to blunt trauma following fall from motorbike.There was no immediate circulatory compromise.Contrasted CT of abdomen revealed an associated left lower abdominal wall traumatic hernia.The iliac artery was intervened with an endovascular stent to restore luminal flow and the hernia was repaired electively.The entire clinical course and management dilemma are described in this article.展开更多
BACKGROUND We report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury.We report that the patient was safely treated by conservative treatment after the obstruction w...BACKGROUND We report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury.We report that the patient was safely treated by conservative treatment after the obstruction was resolved by endoscopic retrograde cholangiopancreatography(ERCP).CASE SUMMARY A 67-year-old man was admitted via the emergency department due to complaints of right-sided abdominal pain that started 2 d prior.Four days prior to presentation,the patient had slipped,fallen and struck his abdomen on a motorcycle handle.His initial vital signs were stable.On physical examination,he showed right upper quadrant pain and Murphy’s sign,with decreased bowel sounds.Additionally,he had had a poor appetite for 4 d.He had been on aspirin for 2 years due to underlying hypertension.Initial simple radiography revealed a slight ileus.The laboratory findings were as follows:white blood cell count,15.5×103/µL(normal range 4.8×10^(3)–10.8×10^(3));hemoglobin,9.4 g/dL;aspartate aminotransferase/alanine transferase,423/348 U/L;total bilirubin/direct bilirubin,4.45/3.26 mg/dL;-GTP,639 U/L(normal range 5–61 U/L);and C-reactive protein,12.32 mg/dL(0–0.3).Abdominal computed tomography showed a distended gallbladder with edematous wall change and a 55 mm×40 mm hematoma.Dilatation was observed in both the intrahepatic and common bile duct areas.Antibiotic treatment was initiated,and ERCP was performed,with hemobilia found during treatment.After cannulation,the patient’s symptoms were relieved,and after conservative management,the patient was discharged with no further complications.After 1-month follow-up,the gallbladder hematoma was completely resolved.CONCLUSION In the case of traumatic injury to the gallbladder,conservative treatment is feasible even in the presence of hematoma.展开更多
Injuries caused by blunt force are seen frequently in daily forensic casework.Sometimes,especially when there is less information about the surrounding circumstances,it might become difficult to figure out the cause a...Injuries caused by blunt force are seen frequently in daily forensic casework.Sometimes,especially when there is less information about the surrounding circumstances,it might become difficult to figure out the cause and background of injuries:accident,criminal violence or self-infliction?In the study presented,face injuries caused by blunt force in 694 cases were analyzed comparing the injury patterns in accidents to those in crimes.It turned out injuries of the ear and retroauricular region clearly indicate a crime.Also,soft tissue injuries of nose,upper jaw,and lower jaw point towards a criminal violence,whereas tooth injuries occur with a similar frequency in both crimes and accidents.展开更多
Central airway injury is a very rare entity during blunt chest trauma. It is serious and may be fatal. Usually, it has fundamental manifestations but in some cases, it is insidious and has been discovered lately. It’...Central airway injury is a very rare entity during blunt chest trauma. It is serious and may be fatal. Usually, it has fundamental manifestations but in some cases, it is insidious and has been discovered lately. It’s suspected when major air leaks from the chest tube and the lung fail to expand despite adequate chest drainage. Right main bronchus injuries are the most frequent. Diagnosis can be suspected clinically and confirmed by Ct scan and bronchoscopy. Conservative management can be applied in special cases but the majority of cases need surgical intervention which depends on primary reconstruction. An early diagnosis and treatment can avoid dramatic complications and provide complete recovery. Associated other organ injury is common and is an important mortality factor. Close cooperation with the emergency team and anesthesiologists is necessary. Here I presented a case of right main bronchus disruption discovered after one year of blunt chest trauma with complete lung atelectasis, managed successfully by resection of the fibrotic injured bronchus and primary reconstruction saving the lung.展开更多
基金The study was approved by Gertner Institute IRB committee(protocol#5138-19,ethical approval number 20187640).
文摘Purpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries,specifically for intra-abdominal injury(IAI).The impact of concomitant spinal cord injury(SCI)with the risk of associated IAI has not been well clarified.The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI.Methods:A retrospective cohort study using the Israeli National Trauma Registry was conducted.Patients with thoracic,lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1,1997 to December 31,2018 were examined,comparing the incidence,severity and mortality of IAIs in patients with or without SCI.The collected variables included age,gender,mechanism of injury,incidence and severity of the concomitant IAIs and pelvic fractures,abbreviated injury scale,injury severity score,and mortality.Statistical analysis was performed using GraphPad InStat?Version 3.10,with Chi-square test for independence and two sided Fisher’s exact probability test.Results:Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures.Combined thoracic and lumbar fractures were observed in 1272 patients(7.5%),isolated thoracic fractures in 4967 patients(29.4%)and isolated lumbar fractures in 10,639 patients(63.0%).The incidence of concomitant SCI was found in 4.95%(63/1272),7.65%(380/4967)and 2.50%(266/10639)of these patients,respectively.The overall mortality was 2.5%,proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts(11.3%vs.4.6%,p<0.001).Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts(8.2%vs.3.1%,p<0.001).There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures;although isolated lumbar f
文摘Background: Morel-Lavallee lesions (MLLs) are rare internal degloving injuries typically caused by blunt traumatic injuries and most commonly occur around the hips and in association with pelvic or acetabular fractures. MLL is often overlooked in the setting of poly-trauma;therefore, clinicians must maintain a high degree of suspicion and be familiar with the management of such injuries, especially in obese poly-trauma patients. Case presentation: We present a 30-year-old female pedestrian struck by a motor vehicle who sustained multiple long bone fractures, a mesenteric hematoma, and full-thickness abdominal skin friction burn which masked a significant underlying abdominal MLL. The internal degloving caused significant devascularization of the overlying soft tissue and skin which required surgical drainage of hematoma, abdominal wall reconstruction with tangential excision, allografting, negative pressure wound therapy, and ultimately autografting. Conclusion: MLL is a rare, often overlooked, internal degloving injury. Surgeons must maintain a high index of suspicion when dealing with third degree friction burns as they may mask underlying injuries such as MLL, and a delay in diagnosis can lead to increased morbidity.
文摘Common or external iliac artery injury due to blunt trauma is unusual without an associated pelvic fracture.Here we report on a 62 years old man that sustained left external iliac artery thrombosis due to blunt trauma following fall from motorbike.There was no immediate circulatory compromise.Contrasted CT of abdomen revealed an associated left lower abdominal wall traumatic hernia.The iliac artery was intervened with an endovascular stent to restore luminal flow and the hernia was repaired electively.The entire clinical course and management dilemma are described in this article.
文摘BACKGROUND We report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury.We report that the patient was safely treated by conservative treatment after the obstruction was resolved by endoscopic retrograde cholangiopancreatography(ERCP).CASE SUMMARY A 67-year-old man was admitted via the emergency department due to complaints of right-sided abdominal pain that started 2 d prior.Four days prior to presentation,the patient had slipped,fallen and struck his abdomen on a motorcycle handle.His initial vital signs were stable.On physical examination,he showed right upper quadrant pain and Murphy’s sign,with decreased bowel sounds.Additionally,he had had a poor appetite for 4 d.He had been on aspirin for 2 years due to underlying hypertension.Initial simple radiography revealed a slight ileus.The laboratory findings were as follows:white blood cell count,15.5×103/µL(normal range 4.8×10^(3)–10.8×10^(3));hemoglobin,9.4 g/dL;aspartate aminotransferase/alanine transferase,423/348 U/L;total bilirubin/direct bilirubin,4.45/3.26 mg/dL;-GTP,639 U/L(normal range 5–61 U/L);and C-reactive protein,12.32 mg/dL(0–0.3).Abdominal computed tomography showed a distended gallbladder with edematous wall change and a 55 mm×40 mm hematoma.Dilatation was observed in both the intrahepatic and common bile duct areas.Antibiotic treatment was initiated,and ERCP was performed,with hemobilia found during treatment.After cannulation,the patient’s symptoms were relieved,and after conservative management,the patient was discharged with no further complications.After 1-month follow-up,the gallbladder hematoma was completely resolved.CONCLUSION In the case of traumatic injury to the gallbladder,conservative treatment is feasible even in the presence of hematoma.
基金supported by a grant of the Interdisciplinary Centre for Clinical Research IZKF of Julius-MaximiliansUniversity of Wurzburg.
文摘Injuries caused by blunt force are seen frequently in daily forensic casework.Sometimes,especially when there is less information about the surrounding circumstances,it might become difficult to figure out the cause and background of injuries:accident,criminal violence or self-infliction?In the study presented,face injuries caused by blunt force in 694 cases were analyzed comparing the injury patterns in accidents to those in crimes.It turned out injuries of the ear and retroauricular region clearly indicate a crime.Also,soft tissue injuries of nose,upper jaw,and lower jaw point towards a criminal violence,whereas tooth injuries occur with a similar frequency in both crimes and accidents.
文摘Central airway injury is a very rare entity during blunt chest trauma. It is serious and may be fatal. Usually, it has fundamental manifestations but in some cases, it is insidious and has been discovered lately. It’s suspected when major air leaks from the chest tube and the lung fail to expand despite adequate chest drainage. Right main bronchus injuries are the most frequent. Diagnosis can be suspected clinically and confirmed by Ct scan and bronchoscopy. Conservative management can be applied in special cases but the majority of cases need surgical intervention which depends on primary reconstruction. An early diagnosis and treatment can avoid dramatic complications and provide complete recovery. Associated other organ injury is common and is an important mortality factor. Close cooperation with the emergency team and anesthesiologists is necessary. Here I presented a case of right main bronchus disruption discovered after one year of blunt chest trauma with complete lung atelectasis, managed successfully by resection of the fibrotic injured bronchus and primary reconstruction saving the lung.
